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Inappropriate ICD therapy due to proarrhythmic ICD shocks and hyperpolarization
Edward Healy1, Sanjeev Goyal, Clifford Browning
1Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts 05181, USA.
Pacing and Clinical Electrophysiology : PACE
|March 11, 2004
Summary
A patient with an implantable cardioverter-defibrillator (ICD) experienced inappropriate shocks due to atrial fibrillation. This led to proarrhythmia and further device oversensing, highlighting potential complications of ICD therapy.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening ventricular arrhythmias.
- Ischemic cardiomyopathy increases the risk of ventricular fibrillation (VF).
Observation:
- A 50-year-old man with ischemic cardiomyopathy received an ICD for inducible VF.
- Sixteen months post-implantation, he developed inappropriate ICD shocks triggered by atrial fibrillation with rapid ventricular response.
Findings:
- The initial ICD shock for atrial fibrillation induced ventricular fibrillation (proarrhythmia).
- Subsequent shocks converted the rhythm to an idioventricular rhythm.
- Lead hyperpolarization caused oversensing of ventricular events, leading to further inappropriate shocks.
Implications:
- This case highlights the potential for inappropriate ICD therapy and proarrhythmia.
- Understanding device behavior during complex arrhythmias is critical for patient management.
- Lead integrity and sensing parameters require careful monitoring post-implantation.